I must confess, I was prepared to hate the list, as I disagreed with much of what she had written about in the previous columns, like choosing between medication and creativity. As I have mentioned before, I do worry that the series will provoke many people to ditch psychotropic drugs without the supervision of a physician, and I pray that no lives are lost as a result.

However, I think Spechler did a good job with her list, which includes everything from making sure you have 24-hour support, tapering slowly, cleaning up your diet, trying out meditation and relaxation techniques, protecting your free time, guarding yourself against the barrage of opinions on depression and how to treat it, and anticipating small pockets of hell here and there.

Her last paragraph reads like that of someone who has been off medication for 20 days, not 20 weeks (which is the case). So as a veteran medication-taker, I wonder if her picture will be as rosy a few months from now — “The time will come when you wake each morning not woozy with dread, but excited that the sun is shining” — but maybe I’m just jealous.

I can’t write a column like Spechler’s because I have yet, in my 25 years on psychotropic medications, been able to go off of my drugs completely.

I tried once when I listened to some well-intentioned friends and family who promised me the land of lollipops and unicorns on the other side of medication. Instead, I ended up being hospitalized, donning a paper robe that hardly covered my butt.

Ten years later, I can see where I erred.

I began my second attempt to go off meds in January of last year. In 18 months, I have successfully weaned myself off of two of my medications. My hope is to continue this process…gradually…until I’m off of everything. It may take another two years. Or it may not be possible. I’m prepared for the latter, as I know that some people simply need to stay on their meds in order to function as decent human beings. I think we should all — as family members, friends, and co-workers — exercise tolerance, understanding, and compassion in wrapping our brains around that concept.

I am not anti-med by any stretch. I just got to a point where the side effects and risks of the drugs were outweighing the benefits.

Lithium affects your thyroid. Eight years into taking it, I developed hypothyroidism. Coincidence? Research has linked the pituitary drug I’m taking to the specific kind of heart valve problem I have. Again…coincidence? Drugs definitely save, no doubt about that. But they aren’t without risks. In my case, they weren’t really working either, which is why I’m trying again.

However, if I learned anything from my first attempt, it’s that weaning isn’t something to be decided over cocktail hour with a group of anti-med folks, and not something to be done without the supervision of a doctor. Here is my top 10 list — not of what I would tell my medicated self, since I’m still medicated — but of the top 10 mistakes I made when weaning the first time.

1. I weaned too fast.

Back in 2005, I was switching medications so fast in the period of a year that my system had no real chance of achieving sanity. In 12 months, I went through more than 20 different medication combinations. Then when I decided that they were all toxic, I went off of two or three within a few weeks. I have learned the hard way that my body is extremely sensitive to change. So taking away two or three drugs in under 20 days sent my system into shock. The second time around, it took me three months to stop taking a single drug.

2. I weaned when I was still depressed.

My psychiatrist said something to me the other day that makes perfect sense: “It takes more medication to make a person well than to keep a person well.” Therefore, your best bet is to wean yourself off of a drug when you’re well. The first time I threw the drugs out, I did so practically on my way back from the psychiatric ward. Not great timing. The second time round, I got off of the first drug when I was still depressed, but I had meticulous records showing the drug wasn’t doing anything anyway. I didn’t attempt the second drug until I hadn’t had death thoughts in several months.

3. I didn’t do anything differently to bolster my health.

In 2006, I didn’t make any other changes before I decided I didn’t need drugs. I ate the same diet. I hadn’t added meditation or yoga. I just thought that my body would miraculously correct itself. This time around, I have invested tremendous time and energy into healing the gut issues that I feel are central to my mood disorder. This means following a strict diet and eliminating gluten, dairy, sugar, caffeine (and alcohol, of course). I’m also working with a gastrointestinal doctor on reversing my intestinal bacteria overgrowth and an integrative doctor on treating my hypothyroidism and managing my pituitary issues.

4. I weaned during a stressful period.

The first time I weaned myself off of antidepressants, my kids were 2 and 4, and I was having developmental issues with both that required physical, speech, and occupational therapy. My son didn’t sleep through the night for the first five years, so I was horribly sleep deprived. I was also having a difficult time adjusting to being a mostly stay-at-home mom, trying to work when they napped (they didn’t nap; that was the problem).

It was stressful. I realize no time is completely without stress, but some are packed with it — like after a divorce, family death, job change, or move across the country. Taking that into consideration, I delayed weaning myself off of the second drug until I completed a work project that was weighing on me, and had some extra time in my schedule in case I had a day here or there, or a week, where I couldn’t stop crying.

5. I weaned during the winter.

Spring is by far the best time to begin the process of weaning yourself off your drugs. Winter is not. I know this now. There’s nothing like going off your drugs cold turkey and then being stuck inside your house with some whiny kids for a week because your city only owns one snowplow.

6. My psychiatrist was bad.

I tried to think of a diplomatic way to say this, but man, this doctor was just clueless when I look back. I think the only question I got was, “Do you have any suicidal plans?” No, I didn’t have any specific plans, but I did think about suicide almost constantly while I weaned off my drugs the first time. This time around, I trust my psychiatrist. She has been with me for 10 years and knows me well.

7. I listened to the wrong people.

First time around, I let the wrong people get inside my head — people who have no concept of what it is like to try to stay alive when everything inside your body wants to be five feet under; people who eat, sleep, and breathe the law of attraction and believe by thinking pretty thoughts that you can simply reverse bipolar disorder or schizophrenia. This time, I am consulting my best friend who has known me for more than 25 years and doesn’t hold back when she sees me heading toward danger. I am enlisting my husband as well so he can communicate as best as he can any red flags he sees.

8. I had no support.

Spechler talks about having that friend you can call in the middle of the night. For me, that’s not enough. I need people who have been through this same thing — who have tried to wean and succeeded. I don’t need cheerleaders who have never had a death thought, because they don’t know what they are talking about. I need the ones who have struggled like me, almost every day, and want really badly to get off this stuff so that they can be even better. And that’s why I created my depression community, ProjectBeyondBlue.com, a group of people like me who struggle with depression but are committed to getting better in creative ways, and to exploring all kinds of integrative health solutions so that they can be better parents and spouses and workers. Now, whenever I have an issue — whether it be diet-related or ruminating thoughts that don’t go away — I can log on any time of the night and find people who understand me and have been there.

9. I wasn’t patient.

The articles I read about getting off medication made it sound so easy. All I had to do was stop swallowing pharmaceuticals for a few weeks. What they didn’t say is that sometimes it might take you almost 100 days to go off of one drug, and that your body isn’t always going to like the change, which is why you have to go about this thing with the patience of Mr. Miyagi (Pat Morita) as he catches flies with chopsticks in The Karate Kid.

10. I was too proud.

The first time around, I never had a conversation with myself:

This may not work. This may not be possible. And if that’s the case, you needn’t feel badly about yourself, because you didn’t do anything wrong. You tried as hard as you could. And going back on medication isn’t a cop-out by any means. You must do what you need to do to be a responsible mom, wife, and citizen of the world.

I was too proud the first time. I blew through all the red flags as I was getting off those toxins, no matter what it took.

This time is different. I know that I don’t know my body as completely as I wish I did. I have been humbled in the past to know she holds many more secrets, insights, and a lot more wisdom that I have yet to learn. I haven’t resolved to accomplish the tapering. I have merely decided to try.

]]>http://www.everydayhealth.com/columns/therese-borchard-sanity-break/mistakes-i-made-trying-to-quit-antidepressants/feed/010 Ways to Cultivate Good Gut Bacteria and Reduce Depressionhttp://www.everydayhealth.com/columns/therese-borchard-sanity-break/ways-cultivate-good-gut-bacteria-reduce-depression/
http://www.everydayhealth.com/columns/therese-borchard-sanity-break/ways-cultivate-good-gut-bacteria-reduce-depression/#commentsThu, 16 Jul 2015 12:50:27 +0000Therese Borchardhttp://www.everydayhealth.com/columns/therese-borchard-sanity-break/?p=4202We are all born with genes that predispose us to all kinds of things — in my case, most of the psychiatric illnesses listed in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition). And while we have some control over the way our genes express themselves or “turn on” — a new science called epigenetics — we are more or less stuck with our human genome. But we are by no means permanently attached to a diagnosis of Major Depression Disorder (if that is what Mom and Dad kindly handed down).

Since there is much we can do to shape the environment within our guts, we have control over our microbiota and can compensate for the lack of control we have over our human genome. Our microbiome contains one hundred times more genes than our human genome, so in fact there is about 99 percent of associated genetic material that we have the potential to mold in ways that are beneficial to us.

Of course, I’m sold on the research because, in the last 18 months, I have conducted my own gut experiment: eliminating sugar, gluten, dairy, and caffeine; drinking at least one kale smoothie a day; breaking up with my favorite pastime of swimming (chlorine kills good bacteria); taking probiotics and coconut oil; and working with a gastrointestinal doctor on reversing SIBO (small intestine bacteria overgrowth) and treating inflammatory bowel disease. The result is that I haven’t had death thoughts in many months, and I’ve been able to wean off two of my psych meds. Since I have spent a considerable chunk of my free time reading up on gut health as of late, I thought I would summarize for you some ways you can cultivate good bacteria, which translates to a more stable, more resilient mood.

1. Cut Out Sugar and Processed Foods

Findings from a new study at Oregon State University found that a diet high in sugar caused changes in the gut bacteria of mice, impairing the mice’s ability to adjust to changing situations, called “cognitive flexibility.” The change in gut bacteria also negatively affected the mice’s long-term and short-term memory.

In this study, which was just published in the journal Neuroscience, the performance of mice on various tests of mental and physical function began to drop just four weeks after being fed a diet high in fat and sugar. Monosaccharides, the simplest carbohydrates containing a single molecule of glucose and fructose (a piece of Wonder bread), disrupt a healthy microbial balance because they are digested very easily by us and absorbed into our small intestine without any help from our microbes. That leaves our gut bugs hungry, with nothing to munch on, so they begin nibbling on the mucus lining of our intestines — which is meant to be a strong barrier between the gut and the rest of the body. When the wall of the intestine is permeated, particles of food enter the bloodstream, and our immune system alerts our brain and other organs to the attack, causing inflammation in various parts of our body. Sugar also feeds organisms like Candida Albican, a kind of fungus that grows in the gut and attacks the intestine wall. These stringy-looking dudes need carbon-based compounds (sugars) to multiply like Gremlins, and when they do, people will start asking you if you’re pregnant — and you’ll feel like you need to up your antidepressant dose.

2. Eat More Plants and Dietary Fiber

Almost every gut expert I’ve read says that changing our diet is the best and most direct route we have for transforming our gut bacteria. They differ on whether or not to include fruits or grains (David Perlmutter, MD, for example, is against grains and says to limit fruit, while the Sonnenburgs promote grains like brown rice and fruit); however, the opinions are unequivocal on eating more plants — especially green leafy vegetables.

By eating more plants, we achieve and maintain microbiota diversity — which is going to lead to a clearer mind and happier disposition. Just as sugar is processed too easily and therefore starves our microbes, dietary fiber, or MACs (microbiota accessible carbohydrates) — a term the Sonnenburgs use throughout their book — give our little guys plenty to feast on. Consuming plenty of MACs (the Sonnenburgs suggest eating 33 to 39 grams of dietary fiber a day) will not only keep our intestinal lining intact, but it will also help us sustain a more varied collection of bacteria, which is paramount to good health.

3. Limit Antibiotics

My dad died at age 56 of pneumonia. Therefore, I know we can’t afford not to use antibiotics at certain points in our lives. But regular antibiotic use kills the diverse community of our microbiota, and therefore wreaks more health hazards than we could have ever imagined when penicillin was first discovered. Broad-spectrum antibiotics don’t discern between what’s beneficial for our health and what’s not: they hold rifles and start firing at whatever comes into their view — some of the collateral damage being strains of bacteria we need to fight other infections. American children are typically prescribed one course of antibiotics a year. The Sonneburgs claim that amount is enough to permanently change children’s microbiota and affect their long-term health. I believe that one of the things that has contributed to my depression in the last four years — and what set off the inflammatory bowel disease (IBD) that I now have — is being flooded with antibiotics when my appendix ruptured in 2011. A person with a healthy microbiota might have fared just fine. However, I went into surgery with a compromised gut, so it’s understandable why my symptoms of depression and anxiety would persist despite trying multiple medications.

4. Get Dirty

Our obsession with sanitization is making us sick. Ironic? The Sonnenburgs cite a May 2013 study published in the journal Pediatrics that found that children whose parents cleaned their dirty pacifier by sucking on it instead of boiling it in water were less likely to have eczema than the kids of the sanitization freaks. Two years ago, a team of scientists discovered why children who grow up in homes with a dog have a lower risk of developing allergies and asthma — they help diversify the microbiome community, of course. The study published in Proceedings of the National Academy of Sciences shows that dog ownership is associated with a kind of house dust that exposes us to important strains of bacteria, like Lactobacillus. I believe it, based on the substantial dust and hairballs that used to grace every corner of our home when we had two Lab-Chow dogs. Soil, especially, has wonderful healing elements that we need. Gardening or weeding can serve as a way of boosting our immune systems.

Most of the gut experts say we ought to be picky about the household cleaners we use to disinfect our homes. Most of them are like antibiotics: they obliterate everything, which includes some of the helpful bacteria we need to stay sane. The Sonnenburgs suggest using less toxic cleaners such as vinegar, castile soap, and lemon juice. Limiting our exposure to such chemicals as chlorine can help protect our health as well. If you’re a swimmer with gut issues, like I was, you might want to think about swapping the activity with a more microbiome-promoting exercise such as yoga. And avoid antibacterial soaps and alcohol-based sanitizers if you can.

5. Take a Probiotic

In December 2013, Sarkis Mazmanian, PhD, a microbiologist at the California Institute of Technology in Pasadena, led a study where he discovered that mice with some features of autism had much lower levels of a common gut bacterium called Bacteroides fragilis than did normal mice. They were stressed, antisocial, and had the same gastrointestinal symptoms often found in autism. Interestingly enough, when the scientists fed the mice B. fragilis (in a probiotic), they reversed their symptoms. In an April 2015 study in the journal Brain, Behavior, and Immunity, researchers in the Netherlands provided a multispecies probiotic to 20 healthy individuals without mood disorders for a four-week period, and a placebo to 20 other participants. According to the abstract:

Compared to participants who received the placebo intervention, participants who received the four-week multispecies probiotics intervention showed a significantly reduced overall cognitive reactivity to sad mood, which was largely accounted for by reduced rumination and aggressive thoughts.

But which probiotic do you take? Even the selection at Trader Joe’s is dizzying. Every expert I’ve read has been hesitant to throw out specific brands and types, because every person’s microbiome is unique and benefits from different strains of bacteria. Dr. Perlmutter encourages people to seek probiotics that contain the following species: Lactobacillus plantarum, Lactobacillus acidophilus, Lactobacillus brevis, Bifidobacterium lactis (B. animalis), and Bifidobacterium longum. I think it’s important to consider shelf life and not get a brand that is required to be refrigerated, because I tend not to trust the manufacturers on making sure the bottle was below a certain temperature before getting to me.

6. Try Fermented Foods

Fermented food is the best kind of probiotic you can feed your gut, because it typically provides a broad combination of bacteria — so chances are greater that you’ll get a useful bacteria. Fermentation is by no means a new health movement. People were fermenting food more than 8,000 years ago. In fact, only recently — since the invention of the refrigerator — have we not placed a priority on consuming fermented foods, which may be part of the reason we have less of a diversity of gut bugs than we used to. One of the easiest, most common fermented products is yogurt (but make sure it is unsweetened). Other examples are kefir, kimchee, sauerkraut, pickles, and kombucha tea. Note: Be careful about alcohol content in some fermented drinks. I didn’t realize that certain kombucha teas and kefir can have a higher alcoholic percentage than beer — a problem for a recovering alcoholic.

7. Lower Stress

When you feel stressed, your body will discharge natural steroids and adrenaline, and your immune system will release inflammatory cytokines. This happens whether the threat is real (a bear is approaching your tent in the woods) or not (you can’t stop obsessing about all of your work deadlines). If you tend to be stressed all the time, your immune response never stops sending inflammation messages to all parts of your body — your gut bugs included. The microbiome helps keep our immune system in check. The pair (intestinal bacteria and our immune response) work very closely together to make sure that foreign agents are evacuated as soon as possible, and that we respond to disease more quickly than the IRS responds to our questions about tax returns. However, chronic immune response weakens the health of our guts, just as an unbalanced microbiome causes all kinds of immune diseases (autoimmune disorders, Crohn’s disease, ulcerative colitis, inflammatory bowel disease). So part of healing your gut — or at least keeping your microbiome vital and diverse — is learning how to chill out.

8. Get Consistent Sleep

This is interesting. Cytokines — or inflammatory messengers — have circadian cycles that are dictated by our gut critters. In his book Brain Maker, Perlmutter explains:

When cortisol levels go up in the morning, the gut bacteria inhibit production of cytokines, and this shift defines the transition between non-REM and REM sleep. Hence, disruption of the gut bacteria can have significant negative effects on sleep and circadian rhythms. Balance the gut, break through insomnia.

The opposite is also true. We balance our guts by practicing good sleep hygiene and getting as close to eight hours of sleep a night as we can. A May 2014 study published in the journal PLOS ONE “demonstrated that circadian disorganization can impact intestinal microbiota which may have implications for inflammatory diseases.”

9. Sweat

Our gut bugs just don’t like for us to be lazy; they are much happier when we get an aerobic workout. A team of scientists from the University College Cork in Ireland studied the poop of 40 professional rugby players. The results showed that the athletes’ microbiomes were far more diverse than those of two control groups of normal people. In a May 2013 control study published in the journal PLOS ONE, 40 rats were assigned to one of four experimental groups: two with free access to exercise, and two with no access to exercise. A significant increase in the number of the bacteria Lactobacillus, Bifidobacterium and B. coccoides–E. rectale group was found in the micriobiota of rats with access to exercise. In other studies, as well, it appears that exercise induces changes in the gut microbiota that are different than, say, diet. “Several physiological changes that result from exercise, such as increasing intestinal transit time (or flow rate) through the gut, influencing metabolism, and altering immune function, are known to affect the microbiota,” the Sonnenburgs explain in their book.

10. Consume Less Red Meat and Animal Products

In an April 2013 study published in the journal Nature, Harvard scientists had a group of nine volunteers go on two extreme diets. First, they ate all meat and cheese. Breakfast consisted of eggs and bacon, lunch was ribs, and for dinner they ate salami and prosciutto with different kinds of cheese. They had pork rinds for snacks. After a break, they began a fiber-rich diet in which all of their foods came from plants. The scientists tracked the changes in the volunteers’ microbiomes, and within two days of eating the animal diet, the bacteria species in the gut changed. They produced more of the microbe Bilophila, which has been found to cause inflammation and intestinal diseases in mice. According to the researchers, after about three days on the diet, the volunteers’ behavior began to be affected by the change in microbiota. “The microbiota of omnivores, compared to that of vegetarians and vegans, produces more of a chemical that is associated with heart disease,” explain the Sonnenburgs. “That compound, trimethylamine-N-oxide (TMAO), is a product of the microbiota metabolizing a chemical abundant in red meat.”

]]>http://www.everydayhealth.com/columns/therese-borchard-sanity-break/ways-cultivate-good-gut-bacteria-reduce-depression/feed/0Depression and Men: Why It’s Hard to Ask For Helphttp://www.everydayhealth.com/columns/therese-borchard-sanity-break/depression-men-why-its-hard-ask-help/
http://www.everydayhealth.com/columns/therese-borchard-sanity-break/depression-men-why-its-hard-ask-help/#commentsMon, 13 Jul 2015 20:11:52 +0000Therese Borchardhttp://www.everydayhealth.com/columns/therese-borchard-sanity-break/?p=4159Fans surprised Supernatural star Jared Padalecki at Comic-Con on Sunday, July 12, by lighting candles in the audience — over 7,000 of them — as a thank you for opening up about his struggles with depression and as a tribute to his Always Keep Fighting campaign that supports people struggling with depression, self-injury, addiction, or suicidal thoughts. You can see Padalecki’s Tweet here:

During filming of the third season of Supernatural, Padalecki broke down in his trailer after shooting an episode. A doctor soon diagnosed him with clinical depression; he was 25 at the time.

According to a June 2015 report from the U.S. Centers for Disease Control and Prevention, close to one in 10 American men suffers from depression or anxiety, but fewer than half get treatment. The poll of more than 21,000 men also found that among younger males, blacks and Hispanics are less likely than whites to report mental health symptoms.

More than 39 percent of the men under age 45 said they had either taken medication or visited a mental health professional for daily anxiety or depression during the previous year, putting these younger men roughly on a par with the estimated 42 percent of “older men” (those 45 years and above) who said they had done the same.

In a September 2014 paper published in Qualitative Health Research, a team of Australian professors explored the problem of stigma as a barrier to men seeking help for mental health. They analyzed portrayals of men’s communication about depression in news articles over a five-year period. They found that by presenting media clips in which men were open about depression, and therefore experienced positive outcomes in their recovery, they could challenge the stigma associated with male depression. According to the abstract:

We suggest that portraying depression as something that impacts a plurality of men is one way that media messages might dispel stigma. We drew recommendations from the findings about the language that could be used by media, mental health campaigns, and health service providers to mitigate the impact of stigma on men’s mental health help seeking.

This is exactly what Padalecki has done in his open confession. In a powerful media clip, he has broken down the walls of stigma that are especially thick for men, and joins other celebrity spokespeople for mental health such as actor Jon Hamm, columnist Art Buchwald, TV host Stephen Colbert, astronaut Buzz Aldrin, performer Adam Ant, Hall of Fame quarterback Terry Bradshaw, television personality Dick Clark, and journalist Mike Wallace.

“I think it’s less socially acceptable for men to be depressed or anxious,” says my friend Thomas, a college professor who has experienced depression and anxiety. “It can be, and has been, written off to women’s hormones or body chemistry in ways that it tends not to be for males, who (it turns out) also have hormones and body chemistry. I think male depression is seen as bearing too much stress from the outside, whereas female depression tends to be seen as something internal — if not self-generated, at least self-originating.

“If it’s true that depression is perceived as a woman’s illness, and I’m inclined to think it is,” Thomas tells me, “it adds a layer to this that is at least an implicit attack on one’s masculinity. And if that’s not an onramp to a vicious cycle, I’m not sure what is.”

Men — more commonly than women — are likely to feel angry, irritable, and frustrated rather than sad when depressed.

Instead of withdrawing from the world, men may act recklessly or develop a compulsive interest in … a new hobby. Instead of crying, men may engage in violent behavior.

Men also are more likely to abuse drugs and alcohol when in the midst of a depression, perhaps to find relief from the pain of depressive feelings.

Changes in sleep habits, such as insomnia or feelings of exhaustion, and appetite changes are often recognized as signs of depression in both men and women, but it’s less well known that headaches; joint, back, or muscle pain; dizziness; chest pain; and digestive problems also may be symptoms. Men report these physical symptoms more often than women, although they are often unaware the symptoms are linked to depression.

I asked my friend Ted, who struggles with depression, if that’s true — if he gets more mad than sad.

“I rarely feel anger when I’m going through a depressed phase,” says Ted. “I often don’t feel much at all, which is particularly awful. Tears come and go with no perceptible trigger — a real bonus is when I’m in public. I find it difficult to open up about this in general, but others open up to me, and that, in turn, helps me bring my issues up for discussion.”

This made me think that while men can experience depression differently, we need to be wary of throwing all mood disorders into two big boxes: male and female. I know plenty of women who respond with rage, not tears, and many men who would be smart to buy stock in Kleenex.

I agree with the Australian professors. The more men — especially celebrity men — discussing symptoms in Tweets and YouTube bites, the better chances we have of increasing the statistic of men who seek treatment for depression.

I, for a long time, have been passionate about people dealing with mental illness and struggling with depression, or addiction, or having suicidal thoughts and, strangely enough, it’s almost like the life I live, as well. These characters that we play on Supernatural, Sam and Dean, are always dealing with something greater than themselves, and I’ve sort of learned from the two of them that they get through it with each other, and with help and with support.

“There’s no shame in having to fight every day,” Padalecki says. “If you’re still alive to hear these words or read this interview, then you are winning your war. You’re here.”

]]>http://www.everydayhealth.com/columns/therese-borchard-sanity-break/depression-men-why-its-hard-ask-help/feed/0Project Semicolon: For Lives That Could Have Ended, But Didn’thttp://www.everydayhealth.com/columns/therese-borchard-sanity-break/project-semicolon-for-lives-that-didnt-end/
http://www.everydayhealth.com/columns/therese-borchard-sanity-break/project-semicolon-for-lives-that-didnt-end/#commentsThu, 09 Jul 2015 23:00:51 +0000Therese Borchardhttp://www.everydayhealth.com/columns/therese-borchard-sanity-break/?p=4106There was a girl in front of me in yoga class yesterday with a long piece of text written on her side. I was squinting to see what it said — I almost pulled out my readers — but then I realized we had mirrors in front of us so she could see me struggling to try to read her skin. I thought I’d better return to tree pose.

I find all tattoos intriguing.

Even the tacky ones that cover an entire body.

They always tell a story that I want to hear.

I am especially intrigued when I see a semicolon, because I know, without having to utter a word to the person who has that specific kind of tattoo, that he or she is a kindred spirit.

Project Semicolon began in April 2013 when founder Amy Bleuel decided that she was going to start a movement of hope — communicated in a simple semicolon tattoo in honor of her father, who took his life 10 years earlier. She posted this announcement on social media outlets:

On April 16, 2013 everyone who self harms, is suicidal, depressed, has anxiety, is unhappy, going through a broken heart, just lost a loved one, etc., draw a semicolon on your wrist. A semicolon represents a sentence the author could’ve ended, but chose not to. The author is you and the sentence is your life.

However, when the first Semicolon Day drew more than 500,000 participants, she realized that the symbol was not just about one person, but a global community of human beings longing to continue their stories and live lives that would inspire others to continue on as well.

Not only is Bleuel a survivor of suicide, she herself has experienced debilitating depression, so much that she has self-harmed at times, and even tried to kill herself. She is familiar with the choice between the period and the semicolon. And is therefore a perfect mental-health grammar guide to educate others about their choices, and to inspire them to pause (and begin again) instead of end.

I had the privilege of speaking with Bleuel this morning. I’ve been following her movement for two years now. Three people forwarded me articles about her this week, so I decided to track her down myself in hopes that I could ask her a few personal questions about the movement, and about her story in particular. I started by asking her about her faith since the movement is faith-based, although she is certainly inclusive of non-believers.

“It was my faith that kept me alive,” Bleuel says. “Considering all of my suicide attempts, I shouldn’t be alive. God intervened. People told me from an early age that I had a calling. I never believed it. Now I do.”

Her faith isn’t a magic cure. She never fell to the floor and rose with new DNA. It involves work and doubt and lots and lots of persistence. Like me and most people with mood disorders I know, she still struggles. It was somewhat reassuring to hear that, given that she has become a media figure and role model for people trying to stay alive.

“I thought I had it all together when I launched this movement two years ago,” Bleuel says, “but I didn’t. I’ve had to pull it together. Now that I’m a public figure, I have to rise to be the person people think I am.”

Her ministry, though, helps her become that person. “Although I still struggle, I am helped immensely by helping others,” she says. “I have made a promise to people that I will stay on the right path. I now am accountable to the people who follow me to make good decisions.”

She also attributes her good health these days to her loving husband of one year. “I can’t have him walk in and find me dead,” she says. “I lost my dad that way, and I could never do that to my husband.”

I congratulated her on all the media buzz this week about her movement. She’s been featured all over — from Mashable to USA Today — and she had another interview with a newspaper lined up after she hung up with me.

“What is the one message that you haven’t been able to communicate in other media outlets, the very thing that could keep someone alive?” I asked her. “What would you like to say to the person who is contemplating ending their life with a period?”

“Don’t believe what you feel in that mindset,” Bleuel says. “There are people who love you and care about you.”

That is, in essence, Project Semicolon’s vision, which includes these words:

The vision is that for the first time conversations are being started.

The vision is that everyone comes together as a community and stands together in support of one another.

]]>http://www.everydayhealth.com/columns/therese-borchard-sanity-break/project-semicolon-for-lives-that-didnt-end/feed/0Surprising Facts About Willpower and Self-Controlhttp://www.everydayhealth.com/columns/therese-borchard-sanity-break/surprising-facts-willpower-self-control/
http://www.everydayhealth.com/columns/therese-borchard-sanity-break/surprising-facts-willpower-self-control/#commentsThu, 09 Jul 2015 00:39:43 +0000Therese Borchardhttp://www.everydayhealth.com/columns/therese-borchard-sanity-break/?p=4064In 1996, psychologist Roy Baumeister, PhD, conducted a cruel experiment. With some of his former Case Western Reserve University colleagues, he studied the effect of tempting participants with scrumptious treats in order to see how much willpower human beings actually have.

He kept the 67 participants in a room that smelled like freshly baked chocolate cookies, then showed them the cookies and other chocolate sweets. Some got to indulge, and others were asked to eat radishes instead. After this torture, the team assigned the participants a difficult geometric puzzle. As you might imagine, the folks who got stuck eating the radishes did far worse on the puzzle than the ones who got to indulge in the treats.

Two years later, Dr. Baumeister published the study in the Journal of Personality and Social Psychology and the concept was born that our willpower is finite. The unlucky peeps who were forced to eat veggies simply no longer had the will to engage in another task that tapped their resolve. They were too tired, and probably ticked off, to work on any puzzle.

Since this groundbreaking research, many other studies have confirmed the case for willpower depletion, or “ego depletion” as it is called by psychologists. The problem is that everything we do in our world requires an element of willpower. According to the American Psychological Association, even basic interactions with others and maintaining relationships can deplete willpower, not to mention keeping your cool through the holidays, trying to crank out two blogs a week in the summer when your office is in your son’s bedroom, and not using four-letter words in front of the kids.

Not everyone agrees that our amount of willpower is fixed.

Four years ago Greg Walton, PhD, assistant professor of psychology at Stanford, and Carol Dweck, PhD, a professor of psychology at Stanford and author of the bestseller Mindset, conducted their own research, which arrived at this surprising conclusion: Willpower is only limited if you think it is. As Drs. Walton and Dweck explained in a New York Times piece, Willpower: It’s in Your Head:

When people believe that willpower is fixed and limited, their willpower is easily depleted. But when people believe that willpower is self-renewing — that when you work hard, you’re energized to work more; that when you’ve resisted one temptation, you can better resist the next one — then people successfully exert more willpower. It turns out that willpower is in your head.

In our latest research we found that when people believe in willpower they don’t need sugar — they perform well whether they consume sugar or not. Sugar helps people only when they think that willpower is sharply limited. It’s not sugar we need; it’s a change in mind-set.

I was on day 28 of a 60-day Candida-SIBO (small intestine bacteria overgrowth) diet, which consists mostly of raw vegetables (but not all of them) and wild salmon, when I joined my sister, sister-in-law, husband, and two kids around two burners for a three-hour dinner that may as well have been hosted by Baumeister.

The first course was cheese: one pot of cheddar, the other Swiss.

I can’t eat cheese.

I can’t eat bread.

I can’t even eat the cauliflower or broccoli.

We move on to the main course.

I can’t eat the juicy filet.

I can’t eat the appetizing shrimp.

I can’t eat mushrooms.

I can’t cook any of my raw tuna (and I am cheating with the tuna because I’m not supposed to eat a large fish — too much mercury) in the oils blended with the white wine because, as a recovering alcoholic, I know if I can taste the wine, I’m going to need three times the willpower that I’m currently exerting to not drink a glass of wine. And I’m exerting a lot of willpower right now.

I can’t dip my raw tuna in any of the delicious sauces they have provided.

They all have gluten.

I order another bottle of sparkling water because I have to do something compulsively. I’m not supposed to drink anything effervescent, but I figure that chugging down sparkling water is better than breaking 26 years of sobriety.

Another hour goes by.

We get to dessert: a pot of milk chocolate and a pot of dark chocolate.

I can’t eat the ripe strawberries or pineapple (or any kind of fruit).

I stare into the pot of dark chocolate and think about sending a care package to all of Baumeister’s participants who got screwed. I feel especially bad for any participants that were on a Candida-SIBO diet because they wouldn’t have been able to eat the cookies or the radishes.

At that moment, I arrived at my conclusion: Willpower is totally limited.

Our resolve is like a muscle that gets fatigued if we overuse it. Three hours of resisting my favorite foods and drinks had completely wiped me out. By the end of the dinner, I just wanted to go home and pass out in my bed, maybe stare at my ceiling fan, even though my only physical exertion in the last 180 minutes had been lifting my fondue fork into the pot without the white wine.

The next day my willpower was gone.

I binged on all the starchy vegetables I’m supposed to avoid. I devoured an entire bag (eight servings) of sugar snap snow peas, an ear of corn, and two bowls of edamame. I inhaled a few strawberries and some slices of cantaloupe, a definite no-no.

There was nothing I could do to control my actions. It was like my fingers and my mouth were controlled by an invisible puppeteer who was laughing his butt off at my lack of resolve over some stupid starchy vegetables.

I decided from then on I was saving my willpower for the important stuff.

]]>http://www.everydayhealth.com/columns/therese-borchard-sanity-break/surprising-facts-willpower-self-control/feed/010 Ways to Prevent Mania and Hypomaniahttp://www.everydayhealth.com/columns/therese-borchard-sanity-break/ways-curb-mania-and-hypomania/
http://www.everydayhealth.com/columns/therese-borchard-sanity-break/ways-curb-mania-and-hypomania/#commentsWed, 01 Jul 2015 18:42:11 +0000Therese Borchardhttp://www.everydayhealth.com/columns/therese-borchard-sanity-break/?p=4002Bipolar disorder is one of the most difficult illnesses to treat because by addressing the depression part of the illness, you can inadvertently trigger mania or hypomania. Even in Bipolar II, where the hypomania is less destabilizing than the often-psychotic manic episodes of Bipolar I, persons often experience from a debilitating depression that can’t be lifted by mood stabilizers and antipsychotics. Antidepressants, though, can cause a person with bipolar to cycle between hypomania and depression.

I have worked with psychiatrists who were too afraid of cycling to risk using antidepressants for bipolar patients. They put me strictly on mood stabilizers and antipsychotics. However, I did not get well. I stayed depressed, and all original thoughts in my brain vanished. My current psychiatrist knows that depression is my primary threat, not so much the hypomania, so she was able to pull me out of the depression with the right combination of antidepressants, but is vigilant for any signs of hypomania. Because I know how vulnerable I am to hypomania, I have learned several strategies to help me stay grounded. By making them part of my life, I have been able to take less lithium, my mood stabilizer, which ensures that I continue producing original thoughts and not get too medicated. Here are 10 tools I use to avert hypomania.

1. Practice Good Sleep Hygiene

Developing good sleep habits is by far the most potent tool for preventing mania and hypomania. There are a handful of studies documenting that sleep deprivation is associated with mania and hypomania. By going to bed at 10 every night and sleeping a good eight or nine hours, we have the power to stop rapid cycling and to reverse mania or hypomania. In a study published in Biological Psychiatry a rapid-cycling patient was asked to remain on bed rest in the dark for 14 hours each night (gradually reduced to 10 hours). Times of sleeping and waking were recorded with sleep logs, polygraphic recordings, and computer-based event recordings. His sleep and mood stabilized when he adhered to a regimen of long nightly periods of enforced bed rest in the dark. The abstract’s conclusion: “Fostered sleep and stabilizing its timing by scheduling regular nightly periods of enforced bed rest in the dark may help to prevent mania and rapid cycling in bipolar patients.”

Good sleep hygiene means you go to bed at the same time every night, ideally before 10:30 p.m. — not one night 2 a.m. and another night 7 p.m.; you sleep at least eight hours a night; and you wake at the same time in the morning. Since many folks with bipolar disorder have sleep disorders, a nighttime routine is often needed. For example, I shut down my computer at 8 p.m. and try not to check my emails or messages on my phone. Reading a disconcerting email at 9 p.m. will keep me up all night. It takes me a good two hours to calm down, so I get out the lavender oil around 8:30 p.m., pull out a real book (not an iBook), and begin to tell my body it needs to seriously chill out.

2. Limit Your Screen Time

CNN did a story a few years ago on iPads (or LCD screens) and sleep. Journalist John D. Sutter asked Phyllis Zee, MD, a neuroscience professor at Northwestern and director of the school’s Center for Sleep & Circadian Biology, if our gadgets can disturb sleep patterns and exacerbate insomnia. Dr. Zee said:

Potentially, yes, if you’re using [the iPad or a laptop] close to bedtime … that light can be sufficiently stimulating to the brain to make it more awake and delay your ability to sleep. And I think more importantly, it could also be sufficient to affect your circadian rhythm. This is the clock in your brain that determines when you sleep and when you wake up.

I absolutely know that to be true, because for awhile, I was reading iBooks for a half-hour before bed and staying awake until 2 a.m. My concern with LCD screens isn’t limited to bedtime. I know from people in my depression community that persons with bipolar disorder have to be careful with LCD screens at all times, as they can make the highly sensitive person hypomanic if the person doesn’t take a break from them. For me and for many fragile persons with bipolar, looking into an LCD screen for too long is like keeping your light therapy sunbox on all day. I made the mistake of firing up that baby from 9 p.m. to midnight right after I got it, and I did not sleep one iota the next day, and felt hypomanic all day long. Keep in mind that not only is the light stimulating, but so is all of the messages and tagging and poking — especially if you have as many social media handles as I do.

3. Avoid Certain People and Places

Most of us have a few people in our lives that appear as though they’ve downed three shots of espresso every time we see them. They are usually great fun and make us laugh. However, the hyperactivity isn’t what you need if you haven’t slept well in a few weeks and are trying to calm down your body and mind. Same goes with places. I don’t dare step foot inside the mall, for example, between Halloween and New Year’s. There is just too much stuff being forced in front of my face. I also hate Toys-R-Us. I still have nightmares about the time my husband pressed three dozen Tickle Me Elmos and the entire shelf began to shake.

4. Pay Attention to Your Body and Breathe Deeply

Before attending the mindfulness-based stress reduction (MBSR) program modeled after the one developed by Jon Kabat-Zinn at the University of Massachusetts Medical Center, I did not pay attention to my body’s cues preceding a hypomanic episode. In fact, it was usually another person who would point out the embarrassing truth — like the time my editor wrote a letter to my doctor after I started publishing eight blogs a day thinking my traffic would go up. Now, though, when my heart races and I feel as though I have consumed eight cups of coffee, I know this is my opportunity to reverse my symptoms by doing lots of deep breathing exercises.

By voluntarily changing the rate, depth, and pattern of breathing, we can change the messages being sent from the body’s respiratory system to the brain. In this way, breathing techniques provide a portal to the autonomic communication network through which we can, by changing our breathing patterns, send specific messages to the brain using the language of the body, a language the brain understands and to which it responds. Messages from the respiratory system have rapid, powerful effects on major brain centers involved in thought, emotion, and behavior.

5. Eliminate Caffeine

A good caffeine rush mimics hypomania. You feel more alive, more alert, like you could actually contribute something of worth to the world. That’s all fine and dandy except when you are teetering on the hypomanic edge. Caffeine can provide the ever-so-subtle push to the other side, especially if you aren’t sleeping well, which is when most people most crave caffeine. Stephen Cherniske, MS, calls caffeine “America’s number one drug” in his book Caffeine Blues because of the withdrawal our body goes through three hours after we’ve drank a cup of coffee or a Diet Coke. Persons with bipolar are even more sensitive to amphetamine-like substances that raise dopamine levels, so the safest way to prevent hypomania is to eliminate the stuff altogether.

6. Exercise

My best workouts have been when I’m either on the verge of becoming hypomanic or when I am ticked off. My usual 10-minute mile goes down to an eight. I start passing people along my route, at the Naval Academy, feeling like Lynda Carter in her Wonder Woman getup. And my swim interval is consistent with the people who swam across the Chesapeake Bay in under two hours. The truth is I have averted many hypomanic episodes by working out until I collapse or at least become tired, which can take a few hours. Two years ago, the only way I was able to sleep was by swimming more than 300 laps a day. There are people for whom vigorous exercise triggers mania, but most experts report on the benefits of exercise for bipolar disorder.

7. Watch Your Sweets

There is a reason why ice cream, Swedish Fish, and animal crackers are comfort food for the bipolar person. The rush of insulin generated by those foods will calm those carbohydrate-craving brain pathways for a bit, until a crash in blood sugar has the person binging again on sweets. It’s a vicious cycle, one that can keep a bipolar person cycling indefinitely.

I will tell you a true story about sugar and bipolar. About 16 years ago, before I knew I was allergic to sugar and that a high-carb diet was the worst thing I could do for my mental health, I would sometimes drink two bottles of Arizona Iced Tea and eat two or three chocolate-chip oatmeal bars for lunch. One day, there was a Horizon milk truck in front of our house with a large cow on the side. I started mooing at the cow. My new husband, behind me, was truly frightened by this and told me to lay off the Arizona Iced Teas and granola bars for awhile. I haven’t mooed at a truck since.

8. Be Careful With the Opposite Sex

I am all for good, healthy friendships between men and women. If you’re not bipolar. Consider me a prude, but I know how difficult it can be to be consistent with good boundaries if you are even the tiniest bit hypomanic. You sincerely didn’t mean for something you sent in an email to sound flirtatious — you were just being playful, like you are with your girlfriends. However, when you do get a reaction from a person of the opposite sex, something in the least bit flattering, that communication can ignite a rush that sends a signal throughout your entire body that you want more of the feel-good hormone it just experienced — dopamine, essentially. It’s even riskier if you have a history of substance abuse and bipolar — because your body will compromise any moral agreements you have signed off on prior to that email in order to get that damn rush again. If you’re not careful, this dangerous game will trigger a full blown manic episode. I have had the best intentions with 85-year-old men, and still, somehow, found myself in trouble. So for the time being, I’m sticking to female friendships.

9. Use a Shopping List

One of the most common manic behaviors is uncontrollable spending or shopping. Therefore, it is sometimes helpful for persons with bipolar disorder to make out a list beforehand of the items you absolutely need to buy — be it a grocery list, a Home Depot run, or a mission to get a your daughter’s friend a birthday gift. That way you won’t end up with 20 different kinds of paint swatches for the kitchen and living room you’ve decided to paint while you were at the store.

10. Allow Time to Decompress

This one is probably the second most important for me to prevent mania. I would say meditate, but that word produces too much expectation and pressure for me right now. Decompressing means after you finish something like a blog post or after you’ve forced yourself to be social for a few hours at a party that you didn’t want to attend, you allow yourselves 15 to 30 minutes to look at the ceiling fan in your bedroom and think about just that: the ceiling fan.

The case has been made that persons with bipolar disorder are creative and therefore need more chill time than the average person. Our brains are operating at a faster pace and more intensely than our non-bipolar friends for the periods of time where we must appear normal. So it is absolutely imperative that we allow some time where nothing is required — where we can drool, or lie in the grass, or doodle, or collapse in front of the front door. Although it seems as though these hours are unproductive, this activity will rebuild the gray matter of our brains and safeguard us from a manic episode.

]]>http://www.everydayhealth.com/columns/therese-borchard-sanity-break/ways-curb-mania-and-hypomania/feed/0The Surprising Role of Nutrition in Mental Healthhttp://www.everydayhealth.com/columns/therese-borchard-sanity-break/the-surprising-role-of-nutrition-in-mental-health/
http://www.everydayhealth.com/columns/therese-borchard-sanity-break/the-surprising-role-of-nutrition-in-mental-health/#commentsWed, 01 Jul 2015 17:46:33 +0000Therese Borchardhttp://www.everydayhealth.com/columns/therese-borchard-sanity-break/?p=3970If you’ve been reading my blog for a month or more, you know that I have found nutrition to be a powerful force in my recovery from depression. Since 2008, I haven’t responded to medications or have had only a minimal, partial response, so I have been on a mission — for myself and for the millions of other people with treatment-resistant depression — to find other, drug-free, ways to lift debilitating depression.

Recently I have been following the research of Julia J. Rucklidge, PhD, professor of clinical psychology at the University of Canterbury in Christchurch, New Zealand, who conducts compelling studies using micronutrients — vitamins and minerals in small quantities — to treat depression and other serious mood disorders.

You can check out Dr. Rucklidge’s research as part of the work conducted by the Mental Health and Nutrition Research Group, and the blog that she writes with Bonnie J. Kaplan, PhD, for Mad in America. Rucklidge recently delivered a fascinating TEDx talk (you can watch it below) about the role of nutrition in treating mental illness. I interview her here so that she can share her research with you.

Therese Borchard: Your research is fascinating. I couldn’t stop reading. If you had to pick two breakthrough studies that you would like everyone who has ever been depressed or has been a loved one of someone depressed read, which studies would you choose?

Julia Rucklidge: The study by Felice Jacka and others published in the American Journal of Psychiatry in 2010 had a tremendous impact when it was published. The study demonstrated an association between habitual diet quality and the high prevalence of mental disorders. I conducted a study in 2012 showing a simple intervention of micronutrients following a natural disaster reduced stress and anxiety and improved mood over just a four-week period. The ADHD randomized clinical trial showed that for those who entered the trial depressed, twice as many went into remission in their depression for those taking the micronutrients compared with those taking placebo.

TB: You said something in your TED talk that intrigued me. You said medications work better initially than they do over time, that drugs save lives, but they often fail to work on a long-term basis. Can you say more about that, and point us to the studies that you mentioned as part of your talk?

JR: We all know of people who have benefited from medications and who would swear that the medication saved them. These reports are really important and there are people who benefit in the long-term. I am sure every psychiatrist has patients like that. But if we look at the data and the published literature, the situation is more uncomfortable.

Stimulants. Most people know that Ritalin is a drug prescribed to treat ADHD. It is typically viewed as the most efficacious drug in child psychiatry because it works quickly. Parents and teachers alike often report a dramatic change in a child who begins taking it. It has been used to treat hyperactivity for almost 80 years but surprisingly, only in the last decade are we learning about the long-term outcomes of people treated with it.

In the United States, there is large clinical trial that has followed 579 ADHD children who were initially randomized for 14 months to receiving various treatments, including medications and psychological treatments. In the first 14 months, those on medications did the best and this reinforced the perception that medications should be the primary way to treat ADHD. But at the end of 36 months, medication use was a significant marker not of beneficial outcome, but of deterioration. That is, participants using medication in the 24-to-36 month period following randomization actually showed increased ADHD symptoms during that interval relative to those not taking medication. Medicated children were also slightly smaller and had higher delinquency scores. At the end of six years, medication use was “associated with worse hyperactivity-impulsivity and oppositional defiant disorder symptoms,” and with greater “overall functional impairment.”

Similarly, in Canada, the Quebec Naturalistic Study found that medicated ADHD girls are more likely to be depressed compared with those not medicated, and boys who are medicated are more likely to drop out of school than those unmedicated. In other words, both of these studies show that while kids do well in the short-term on these medications, in the long-term they do worse.

Antidepressants. In 2012, about half a million New Zealanders were taking an antidepressant, a rate 38 percent higher than five years previously. But despite this increasing reliance on these drugs, outcomes for depressed people can be worse than they were before the advent of antidepressants. In 2014, a paper in the Australian and New Zealand Journal of Psychiatry compared the outcomes of people who were depressed prior to the advent of antidepressants with the outcomes of people who were depressed since the widespread use of antidepressants. If the drugs are working, then the recovery rates and relapse rates should be better now than 50 years ago. They aren’t. This review provided no support for the belief that pharmacological treatments have resulted in an improvement in the long-term outcome of patients with mood disorders.

Other research shows that in some cases, antidepressants have altered the course of disease in negative ways. For example, young people prescribed antidepressants are more likely to convert to bipolar illness than those not medicated. A study in 2004 in the Archives of Pediatrics and Adolescent Medicine showed that those people with anxiety and depression who were treated with antidepressants converted to bipolar illness at a rate of 7.7 percent per year, three times the rate for those not exposed to the drugs, with pre-pubertal children at highest risk for conversion. These means antidepressants are a risk factor for developing another psychiatric illness, bipolar disorder.

Antipsychotics. Similar to prescription trends around the world, prescription rates for antipsychotics more than doubled in this country from 2006 to 2011. But are these medications helping patients in the long-term? Aside from the serious side effects such as weight gain and increased risk for diabetes, a study that came out last year in JAMA Psychiatry should make us seriously consider whether long-term use of these drugs is doing more harm than good. The study was a seven year follow up of a randomized controlled trial and demonstrated that those people with schizophrenia who were randomized to dose reduction or discontinuation of drugs were twice as likely to recover as those who remained at their original dose of medications. Again, we see that medications are increasing relapse rates in the long-term.

TB: You presented at the last American Psychiatric Association conference about using micronutrient to treat depression and said the reception among psychiatrists was better than previous years. Do you think that the more data we have to support the use of micronutrients, the more doctors will introduce this concept? Or will the information not get through because the profit margins aren’t the same as with pharmaceutical medication?

JR: I think there are a lot of challenges to this work becoming mainstream and for physicians to start suggesting it in their mainstream practices. There will be concerns about it not being evidence-based or that they may be liable if something goes wrong. There is also the challenge of which formula to recommend? Which blend of nutrients? However, given that there are quite a few people writing about psychiatry under the influence of drug companies, maybe there will be a change in behavior. Perhaps if there could be independent reviews of whether what we currently do is working people might pay attention to the fact that we have a seriously comprised system for treating people with mental health issues.

TB: What else would you like people to know about treating depression and other mood disorders with micronutrients?

JR: I think it is worth giving it a go first to seriously change diet and if necessary, try a broad spectrum micronutrient supplement, and if that approach doesn’t work, then there is always medication to fall back on.

]]>http://www.everydayhealth.com/columns/therese-borchard-sanity-break/the-surprising-role-of-nutrition-in-mental-health/feed/0Why It’s OK to Be a ‘Difficult’ Patienthttp://www.everydayhealth.com/columns/therese-borchard-sanity-break/dont-be-afraid-to-be-a-difficult-patient/
http://www.everydayhealth.com/columns/therese-borchard-sanity-break/dont-be-afraid-to-be-a-difficult-patient/#commentsMon, 29 Jun 2015 16:20:50 +0000Therese Borchardhttp://www.everydayhealth.com/columns/therese-borchard-sanity-break/?p=3881One of my favorite Seinfeld episodes is the one where Elaine snoops inside her medical chart and reads “patient is difficult.”

The doctor takes a look at her rash and says, “Well, this doesn’t look serious,” and writes something in the chart.

“What are you writing?” she asks.

He sneers and walks out the door.

Wanting a fresh start, she goes to see another doctor, and realizes her chart follows her there. The new doctor greets her warmly until he reads the comments.

He glances at her arm and says impatiently, “This doesn’t look serious.”

“But it really itches,” she complains.

He writes something else down in the chart and walks out.

So Kramer, disguised as Dr. van Nostrum, tries to steal the chart, telling the medical office that Elaine is dying.

They don’t buy it and begin a chart on him.

I think my chart must be atrocious by now.

But oddly enough, I don’t care.

I spent the first 42 years of my life trying to be the perfect, low-maintenance patient, placing all my trust in my doctors to get me well. I never questioned their reasoning behind a treatment plan, and automatically filled every prescription they gave me. Even after a very dangerous psychiatrist nearly killed me with all of the antipsychotic concoctions he pushed on me, I still let physicians do the thinking for me because I didn’t want to have a bad report card in my file, feedback like “patient refuses to cooperate.” My people-pleasing baggage as an adult child of an alcoholic followed me to each appointment, urging me to make the doctor feel good about himself.

I didn’t have enough faith in myself that I could steer my own ship toward health.

But that is changing.

With lots of sweat and self-assertion exercises.

For example, I am working with a new doctor because I may have Crohn’s disease, in addition to small intestine bacterial overgrowth, and other gut issues. The nurse sent me home with a treatment plan and I followed it for two days before the alarm went off in my head: “Is this really the best treatment plan for me?” my inner physician asked me. “Don’t you want to think about this a little and do some research before you just blindly follow the instructions?”

I bought the supplements I am supposed to take. But after looking more carefully at the ingredients and doing my own research, I decided that I didn’t feel comfortable taking them.

“Am I being difficult? Should I just trust this guy?” I asked my husband. “He probably knows more about gut issues than I do.”

The man who has visited me at two inpatient psychiatric units looked at me for a good ten seconds.

“After all you’ve been through in the last ten years,” he said, “you seriously think he knows more about your health than you do? Just because he has a medical degree, you think he’s smarter than you?”

It was my husband that inspired my take-charge-of-your-health transformation a year and a half ago. He was suffering from hives all over his body and had been to several allergists over a period of a year. They all blew him off, treating him much like Elaine: “Not serious, take Zantac.” When he raised the possibility of food allergies, all three arrogantly dismissed his theory.

As he delved into books about how to prevent inflammation, he found a lot of material that pertained to depression.

One cold evening in January 2004 he confronted me.

“You have been severely depressed for five years,” he said. “You are going on six years of continuous death thoughts. You have tried, what, 40 or 50 different medication combinations in the last ten years? Wake up! The psychiatric approach you’re taking is obviously not working.”

At the time I was on four different psych meds and I still very much wanted to die. I knew in my gut that trying medication combination No. 51 or adding yet a fifth medication to my mix was not the answer. But my psychiatrist had saved me from a suicidal depression in 2006 so I had placed her high on a pedestal. I was terrified of deviating from the path she was guiding me down.

After several sleepless nights, I walked into her office and blurted out my truth. “This isn’t working,” I said. “I need to explore a more holistic path.”

We agreed to start weaning off as much medication as possible as long as I remained stable. Because she is the most open-minded psychiatrist I have ever known, she didn’t throw me out of her office or make me feel like a thoughtless fool like Eric’s doctors did, but instead embarked on the journey with me — reading more on gut health, inflammation, and diet.

A year and a half later, she sees my progress and is taking note of it for other patients.

It is easy to regard our doctors as superheroes, omniscient authority figures from whom approval feels necessary. To question something they say or disagree with a strategy toward health can seem disloyal, defiant, or insolent. But no one knows our health better than we do. When we give that power away to anyone, we diminish our possibility for full recovery and rob ourselves of the chance to get as well as we can be.

And the selfsame well from which your laughter rises was oftentimes filled with your tears.

And how else can it be?

The deeper that sorrow carves into your being, the more joy you can contain.

I thought of his words yesterday as I watched Disney’s new movie Inside Out, which I believe is as beneficial as a month of psychotherapy sessions. Watching it with your kids is even better: cheap family therapy. We could all use a reminder of the various characters — Joy, Fear, Anger, Disgust, and Sadness — that live within us, and how our temperament is colored by the guy who is hogging the control pad of our brain.

As a person who has struggled with depression for most of her life, I was especially intrigued by the relationship between Joy and Sadness. I laughed when Joy draws a small circle toward the back of Headquarters and tells Sadness her job is to stay within that space. How many times have I given the same order to my depression? “WHY CAN’T YOU JUST LEAVE ME ALONE??!! FOR THE LAST TIME … GET OUT OF MY LIFE!!” For most of Inside Out, all Joy wants to do is get rid of the blue-ness that messes everything up. However, a few key moments in the pair’s odyssey back to Headquarters teach Joy the critical role of Sadness in the well-being of Riley, the girl whom they are inside, and how Joy and Sadness are more connected than she ever suspected.

I think most of us feel like Joy with that piece of chalk in hand, wanting to delegate our sorrow to the farthest, tiniest corner in our brain. As a society, we are uncomfortable sitting with a friend who has just been diagnosed with cancer and not saying anything — no platitudes, no advice, no jokes — just letting her tears fall wherever they may, as Sadness did with Riley’s imaginary friend, Bing Bong, when he rehashed his traumatic past.

In fact, we force happiness so much in our culture that it breeds unhappiness. In Man’s Search for Meaning, Holocaust survivor Viktor Frankl quoted Edith Weisskopt-Joelson, late professor of psychology, who said:

Our current mental-hygiene philosophy stresses the idea that people ought to be happy, that unhappiness is a symptom of maladjustment. Such a value system might be responsible for the fact that the burden of unavoidable unhappiness is increased by unhappiness about being unhappy.

Findings from my own research suggest that sadness can help people improve attention to external details, reduce judgmental bias, increase perseverance, and promote generosity. All of these findings build a case that sadness has some adaptive functions, and so should be accepted as an important component of our emotional repertoire.

In one of his studies, participants rated the likely truth of 25 true and 25 false trivia statements. Afterwards they were told if each was actually true. Two weeks later, only sad participants were able to accurately distinquish between the true statements and the false claims. The happy folks were more inclined to rate all of the previously seen statements as true.

However, we are so negatively biased in our assessment of this “problem emotion” — programmed in us through everything from sitcoms and media headlines to self-help literature and motivational speakers — that we don’t even flinch when people like Randy Pausch, the famous deceased Carnegie Mellon professor, ask questions like: “You have to decide … Are you a Tigger or an Eeyore?”

Because the world needs its share of Eeyores: solemn, highly-sensitive, realistic, pensive creatures. Moreover, Eeyore exists in each of us — he balances out the annoyingly hyperactive Tigger. None of us are 100 percent Tigger or Eeyore. We aren’t completely Joy or Sadness. We are both and so much more.

Gibran writes:

When you are joyous, look deep into your heart and you shall find it is only that which has given you sorrow that is giving you joy.

When you are sorrowful look again in your heart, and you shall see that in truth you are weeping for that which has been your delight.

I will think of those wise words when I’m trying to force Joy to take over command central in my noggin and push Sadness back into her petite circle. Inside Out does a beautiful job of teaching us that we need all of our feelings — even Disgust, Fear, and Anger — and that the more we expand our vocabulary of emotions and become aware of the movement of each within the gray matter of our brain, the more resilient we will be to cope with life’s unexpected turns and twists.

1. Hand Massage

I learned this one in both the MBSR program and in Brukner’s book. What’s great about it is that you can do it while attending a lecture, listening to your kids fight, or sitting at your desk working. No one will notice. Simply use the thumb of one hand and press around the palm of the other hand. It’s very soothing.

2. Palm Push

By pushing your palms together and holding for five to ten seconds, you give your body “proprioceptive input,” according to Brukner, which “lets your body know where it is in space.” I like this one because it reminds me of tree position in yoga, which is the last of the standing series postures in Bikram yoga. By then, I am quite happy to hold the tree position. The palm push is like a mini, portable tree position I can pull out any time to calm down.

3. Closing Your Eyes

Aron says that 80 percent of sensory stimulation comes in through the eyes, so shutting them every now and then gives your brain a much-needed break. She also says that she has found that highly sensitive persons do better if they can stay in bed with their eyes closed for nine hours. They don’t have to be sleeping. Just lying in bed with our eyes closed allows for some chill time that we need before being bombarded with stimulation.

4. Mindful Sighing

During the MBSR class, we would take a few mindful sighs between transitioning from one person speaking to another. Basically you breathe in to a count of five through your mouth, and then you let out a very loud sigh, the sound you hear your teenager make. I was always amazed at how powerful those small sighs were to adjust my energy level and focus.

5. Mindful Monkey Stretch

A couple of times during the MBSR class, we would stand in back of our chairs, move at least an arm’s length from each other in a circle, and do these exercises that I call mindful monkey stretches. We brought our hands, arms extended, in front of us, then brought the arms down. Next we brought our arms (still extended) to our sides, and then down. Next we brought our arms all the way past our heads and then swooped down, our head dangling between our knees, and hung there for a second. This exercise is extremely effective at releasing the tension we hold in different parts of our body. Our teacher said she does it before her lectures and it works to release the jitters.

6. Hugging Yourself

Did you know that a ten-second hug a day can change biochemical and physiological forces in your body that can lower risk of heart disease, combat stress, fight fatigue, boost your immune system, and ease depression? You can begin by giving yourself a hug. By squeezing your belly and back at the same time, you are again giving yourself proprioceptive input (letting your body know where you are in space), says Brukner, which can help stabilize you.

7. Wall Push

Another great exercise to ground kids (and I add adults) with sensory integration issues, according to Brukner, is the wall push, where you simply push against the wall with flat palms and feet planted on the floor for five to ten seconds. If you’ve ever experienced an earthquake, you can appreciate why this gesture is calming … placing the weight of our body against a solid, immobile surface and feeling the pull of gravity is stabilizing, even on a subconscious level.

8. Superman Pose

If you do Bikram yoga, the superman pose is basically the full locust position (airplane position), except the arms and the hands are stretched out in front of you, not to the sides. “Lie on your belly on the floor,” explains Brukner. “Extend your arms in front of you, and hold them straight out. Extend your legs behind you and hold them straight out.” Hold that pose for ten seconds. It’s a great exercise if you are groggy, overexcited, distracted, or antsy.

9. Shaking

Did you know that animals relieve their stress by shaking? Lots of animals like antelopes shake off their fear after being frozen in panic to escape a predator. In the MBSR program, we practiced shaking, for like 15 minutes at a time. I can’t say it looked all that pretty, but neurologically, I do believe it was beneficial.

10. Bubble Breath

My favorite exercise in Brukner’s book is the Bubble Breath, because it is so simple and calming. Brukner explains:

Breathe in for five seconds, out for five seconds.

Imagine you have a wand of bubbles. When you breathe out, be careful not to pop it.

Place one flat palm on your heart, one flat palm on your belly.

Breathe in through your nose and hold your breath for five seconds.

Breathe out a large “bubble” though pursed lips, blow out for five seconds.